Practice Based Learning: Is bronchoscopy recommended for recurrent croup and is recurrent croup associated with asthma/atopic disease?

Meral Patel, MD

Presented by Meral Patel, MD

Clinical Questions: 

  1. Is bronchoscopy recommended for all patients with recurrent croup?
  2. Is recurrent croup frequently associated with asthma/atopic disease or any other diagnoses?

Key Points:

  • Bronchoscopy is recommended after 2-3 episodes of croup because diagnosis at a lesser severity allows for earlier treatment to halt the progression of disease and to prevent exacerbation of underlying airway narrowing processes
  • We should have a higher index of suspicion for finding airway disorders in children less than 3 years old with recurrent croup.
  • Consider silent reflux if no structural airway disorders are identified on bronchoscopy
  • If signs of silent gastroesophageal reflux are found, or if it is suspected, strongly consider starting antacids
  • Current studies deny a cause-effect relationship between reactive airway disease/asthma and recurrent croup

References:

Cooper T, Kuruvilla G, Persad R, El-Hakim, H. Atypical Croup: Association with Airway Lesions, Atopy and Esophagitis. Otolaryngology – Head and Neck Surgery 2012, 147: 209-214

Chun R, Preciado D, Zalzal G, Shah R. Utility of Bronchoscopy for Recurrent Croup. Annals of Otology, Rhinology and Laryngology 2009, 118: 495-499

Hoa M, Kingsley E, Coticchia J. Correlating the Clinical Course of Recurrent Croup with Endoscopic Findings: A Retrospective Observational Study. Annals of Otology, Rhinology and Laryngology 2008, 117: 464-469

Jabbour N, Parker N, Finkelstein M, Lander T, Sidman J. Incidence of Operative Endoscopy Findings in Recurrent Croup. Otolaryngology – Head and Neck Surgery 2011, 144: 596-601

Kwong K, Hoa M, Coticchia J. Recurrent Croup presentation, diagnosis and management. American Journal of Otolaryngology 2007, 28: 401-407

2 thoughts on “Practice Based Learning: Is bronchoscopy recommended for recurrent croup and is recurrent croup associated with asthma/atopic disease?

    • Dr. Patel’s reply: “When I started looking up recurrent croup, I found out that it is an umbrella term which includes viral, spasmodic (no URI prodrome or fever), and atypical croup (outside of normal age range of 6 mo – 6 yrs). I also read that ~6.4% of the pediatric population has multiple bouts of croup-like symptoms. However, with a structurally normal airway, more than 1 episode of croup within a single season is not common unless the patient had immunodeficiency or is infected with a different viral strain.”

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s